Nurses are the backbone of all of the health care professions: we care for people and communities in difficult situations. We are compassionate and ethical. We put ourselves at risk daily for everything from violence from patients and families to contacting contagious diseases to post-traumatic stress from what we witness.

Here is some of what I have read about on the social media COVID19 for nurses and healthcare providers pages that are popping up faster than dandelions.

1. There is poor planning by, and a lack of communication from, most hospital systems, likely in part impacted by the lack of leadership at the state level. A national survey of nurses by National Nurses United found “high percentages of hospitals do not have plans, isolation procedures, and policies in place for COVID-19; that communication to staff by employers is poor or nonexistent; that hospitals are lacking sufficient stocks of personal protective equipment (PPE) or are not making current stocks available to staff; and have not provided training and practice to staff on how to use PPE properly”. https://www.nationalnursesunited.org/press/survey-nations-frontline-registered-nurses-shows-hospitals-unprepared-covid-19
2. Personal Protective Equipment is now rationed. In inpatient settings, some nurses are asked to use just one mask/ day. An article in the New YorkTimes details how nurses are begging for PPE: https://www.nytimes.com/2020/03/05/us/coronavirus-nurses.html 

• In the home care settings, nurses are asked or told to use one mask and one gown/ day. Obviously, this means they can’t maintain or implement proper precautions when traveling from house to house, the gown itself potentially becomes a contaminant.
• In the home care setting, patients are canceling appointments because they view the nurses as vectors. In the long run, this could have huge implications for greater levels of care needed by these patients if they decline without proper care and guidance.

2. Most facilities do not have plans in place for the forthcoming surge in COVID19 patients.

3. The Centers for Disease Control rolled back the N-95 mask requirement and has stated that a simple surgical mask is sufficient in caring for COVID19 suspected or confirmed patients, and that may be used for extended periods while caring for multiple patients. They also have decided that reusable gowns are fine to use. https://www.fda.gov/medical-devices/letters-health-care-providers/surgical-mask-and-gown-conservation-strategies-letter-healthcare-providers

4.  Fears of getting sick themselves are rampant amongst nurses and other providers. Pregnant nurses have no idea if a COVID19 infection might affect their pregnancy. Those nurses with existing health conditions who are at risk are not sure if they should come into work, or reveal their health conditions to the workplace, or risk losing their jobs. Additionally, nurses who come home to care for elderly relatives, children, etc. are petrified of making them sick.

5. Nurses are not offered COVID19 testing, and if they have symptoms, they are often being told to use vacation, paid time off, or leave without pay, and to self-quarantine and contact the workplace in 14 days.  Those who are at risk are not identified quickly. https://www.theverge.com/2020/3/5/21166088/coronavirus-covid-19-protection-doctors-nurses-health-workers-risk

6.  Nurses may be mandated to work overtime, which can wreak havoc on stress levels and immune responses. https://www.fda.gov/medical-devices/letters-health-care-providers/surgical-mask-and-gown-conservation-strategies-letter-healthcare-providers

The CDC and NIOSH recognized years ago that working 12-hour shifts alone may be dangerous, with deteriorating performance on psychophysiological tests and an increase in risk for injuries. Poor outcomes and personal capabilities worsen with 12-hour shifts worked particularly in combination with working more than 40 hours. Working overtime obviously leads to physical fatigue, and it also increases risks for alcohol use and cigarette smoking. And there is still a lot we don’t know, such as how does working longer impact women or older workers? What about those with pre-existing or chronic conditions? What is the influence of occupational exposure?

What can we do, and what are nurses doing?

Now is the time: we are going to have to advocate for ourselves. We also need to demand proper access to PPE, PPE training, proper testing approaches, and call for OSHA standards related to the risks we face.

• The Ohio Nurses Association is advocating for the availability of more PPE: https://www.wvxu.org/post/ohio-nurses-advocate-additional-supplies-prevent-spread-covid-19#stream/0
• The National Nurses United is calling for our health care systems to dramatically ramp up hospital readiness instead of rationing: https://www.nationalnursesunited.org/press/nurses-time-sharply-ramp-health-care-capacity-covid-19
• NNU also has a recording you can listen to gather more information and consider the next steps: https://www.nationalnursesunited.org/covid-19.
• The ANA and the American Hospital Association have requested more funding to help support efforts: https://www.modernhealthcare.com/safety-quality/qa-ana-president-advocates-readiness-fighting-covid-19.To download the letter, visit here: https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/corona-virus-letter/
• On March 11, the ANA sent a letter to Mike Pence asking that nurses be consulted around major policies developed to address COVID19, flexible licensure and telehealth are enacted to ensure adequate staffing in hard-hit areas, and that federal sick pay leave be granted for all healthcare workers quarantined due to exposure or contracting COVID19 in the course of their work. https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/corona-virus-letter/
• On March 12, the ANA called for congress to require the CDC provides data-driven transmission science behind the decision to change the masking requirements toward less protective measures. https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/corona-virus-letter3/ 
• On March 12, the ANA, AMA, and AHA contacted Mike Pence to declare a national emergency/ disaster to enact the Stafford Act. The Stafford Act would allow for an orderly and systematic federal response when states are overwhelmed. https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/corona-virus-letter-AHAAMAANA/
• The Stafford Act was enacted, though historically it is rarely used for public health disaster issues: https://www.forbes.com/sites/mattperez/2020/03/13/the-stafford-act-invoked-by-president-trump-has-rarely-been-used-for-public-health-emergencies/#98543831fd32
• The Emergency Nurses Association has a plethora of information: https://www.ena.org/practice-resources/covid-19

We can all act as advocates locally to call for safe working conditions, and we can join forces with our national nursing organizations to continue to call for support, funding, and access to proper PPE.

Feel free to share your ideas here.